Provider Demographics
NPI:1427070663
Name:GUNN, SUSAN ARNOLD (NP)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ARNOLD
Last Name:GUNN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 CHASSIN AVE
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4204
Mailing Address - Country:US
Mailing Address - Phone:716-838-6156
Mailing Address - Fax:716-626-4271
Practice Address - Street 1:5330 MAIN ST
Practice Address - Street 2:SUITE 240
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5360
Practice Address - Country:US
Practice Address - Phone:716-626-9016
Practice Address - Fax:716-262-4271
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400994363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRN-364004OtherRN LICENSE
NYF400994OtherNP LICENSE NUMBER